一项基于大脑可塑性原理的认知训练计划：基于可塑性的适应性认知训练改善记忆（IMPACT）研究的结果。
A cognitive training program based on principles of brain plasticity: results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study.
作者信息
Smith Glenn E, Housen Patricia, Yaffe Kristine, Ruff Ronald, Kennison Robert F, Mahncke Henry W, Zelinski Elizabeth M
机构信息
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905, USA.
出版信息
J Am Geriatr Soc. 2009 Apr;57(4):594-603. doi: 10.1111/j.1532-5415.2008.02167.x. Epub 2009 Feb 9.
OBJECTIVES
To investigate the efficacy of a novel brain plasticity-based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant-reported outcomes.
DESIGN
Multisite randomized controlled double-blind trial with two treatment groups.
SETTING
Communities in northern and southern California and Minnesota.
PARTICIPANTS
Community-dwelling adults aged 65 and older (N=487) without a diagnosis of clinically significant cognitive impairment.
INTERVENTION
Participants were randomized to receive a broadly-available brain plasticity-based computerized cognitive training program (intervention) or a novelty- and intensity-matched general cognitive stimulation program modeling treatment as usual (active control). Duration of training was 1 hour per day, 5 days per week, for 8 weeks, for a total of 40 hours.
MEASUREMENTS
The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality (RBANS Auditory Memory/Attention). Secondary measures were derived from performance on the experimental program, standardized neuropsychological assessments of memory and attention, and participant-reported outcomes.
RESULTS
RBANS Auditory Memory/Attention improvement was significantly greater (P=.02) in the experimental group (3.9 points, 95% confidence interval (CI)=2.7-5.1) than in the control group (1.8 points, 95% CI=0.6-3.0). Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group (word list total score, word list delayed recall, digits backwards, letter-number sequencing; P<.05), as did the participant-reported outcome measure (P=.001). No advantage for the experimental group was seen in narrative memory.
CONCLUSION
The experimental program improved generalized measures of memory and attention more than an active control program.
目的
研究一种基于大脑可塑性的新型计算机化认知训练方案对老年人的疗效，并评估其对未经训练的记忆和注意力指标以及参与者自我报告结果的影响。
设计
多中心随机对照双盲试验，设有两个治疗组。
地点
加利福尼亚州北部和南部以及明尼苏达州的社区。
参与者
65岁及以上未被诊断为具有临床显著认知障碍的社区居住成年人（N = 487）。
干预措施
参与者被随机分配接受一种广泛可用的基于大脑可塑性的计算机化认知训练方案（干预组），或一种与新颖性和强度匹配的常规治疗模拟的一般认知刺激方案（积极对照组）。训练时长为每天1小时，每周5天，共8周，总计40小时。
测量指标
主要结局是根据使用听觉模态的神经心理状态评估可重复性成套测验的六个子测验计算得出的综合分数（RBANS听觉记忆/注意力）。次要指标来自实验方案的表现、记忆和注意力的标准化神经心理评估以及参与者自我报告的结果。
结果
实验组（3.9分，95%置信区间（CI）=2.7 - 5.1）的RBANS听觉记忆/注意力改善显著大于对照组（1.8分，95%CI = 0.6 - 3.0）（P = 0.02）。多项记忆和注意力的次要指标显示实验组有显著更大的改善（单词列表总分、单词列表延迟回忆、倒背数字、字母 - 数字排序；P < 0.05），参与者自我报告的结局指标也是如此（P = 0.001）。在叙事记忆方面未发现实验组有优势。
结论
与积极对照方案相比，实验方案在记忆和注意力的综合指标改善方面更优。
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